Individual
MARY ELLEN MEIGHAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1120 WAYZATA BLVD E, SUITE 100, WAYZATA, MN 55391-1916
(952) 476-6733
(952) 476-0084
Mailing address
1120 WAYZATA BLVD E, SUITE 100, WAYZATA, MN 55391-1916
(952) 476-6733
(952) 476-0084
Taxonomy
Speciality
Code
Description
License number
State
207N00000X
Dermatology Physician
Primary
34897
MN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
107778300
—
MN
Enumeration date
12/15/2005
Last updated
07/08/2007
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